Endocrinologists order too many unnecessary tests and treatments, driven by unclear disease definitions, excessive testing habits, and fear of missing diagnoses. According to Gram Research analysis, these low-value practices harm patients through anxiety and unnecessary medications while wasting healthcare resources, yet international programs like Choosing Wisely show that reducing unnecessary care requires changing doctor culture and healthcare systems, not just publishing guidelines.
Doctors in endocrinology, the field treating hormones and metabolism, often order more tests and treatments than patients actually need. According to Gram Research analysis, this “low-value care” happens because of unclear disease definitions, too much testing, and habits that favor treating rather than waiting. A new review examines why this happens and shares strategies from programs like Choosing Wisely to help doctors provide better, more focused care that truly helps patients without causing unnecessary worry or expense.
Key Statistics
A 2026 narrative review in the Journal of Evaluation in Clinical Practice found that low-value care is highly prevalent in endocrinology, driven by extensive diagnostic testing and evolving disease definitions that expand who is considered sick.
Research shows that unnecessary diagnostic-therapeutic cascades in endocrinology increase patient psychological burden and healthcare costs without improving clinically meaningful health outcomes.
International initiatives like Choosing Wisely and Right Care provide actionable tools to reduce low-value endocrine care, but their impact remains limited due to clinical inertia and cultural norms favoring intervention over watchful waiting.
A 2026 review found that reducing low-value care in endocrinology requires transformative changes in clinical culture and healthcare systems, not only evidence-based recommendations, to ensure care maximizes benefit while minimizing harm.
The Quick Take
- What they studied: Why endocrinologists (hormone doctors) order too many tests and treatments, and what can be done to stop unnecessary care
- Who participated: This was a review of existing research and international programs, not a study with patient participants
- Key finding: Doctors order excessive tests and treatments in endocrinology due to unclear guidelines, habit, and fear of missing diagnoses, leading to unnecessary harm and costs without better patient outcomes
- What it means for you: If you see an endocrinologist, ask why specific tests are needed. Understanding that some tests may not change your treatment can help you make informed decisions with your doctor about what’s truly necessary
The Research Details
Researchers reviewed published studies and examined major international programs that help doctors reduce unnecessary care. They looked at initiatives like Choosing Wisely and Right Care, which publish lists of tests and treatments doctors should avoid. They also studied recommendations from Spain’s endocrinology society about what doctors should stop doing. The review combined all this information to understand why low-value care happens in endocrinology and what solutions work best.
The researchers focused on three main problems: doctors ordering too many diagnostic tests, changing definitions of diseases that make more people seem sick, and uncertainty in deciding when to treat. They examined how these problems create chains of unnecessary tests and treatments that can harm patients psychologically and financially without improving their actual health.
Understanding why unnecessary care happens is the first step to fixing it. By examining real-world programs and research, this review helps doctors and healthcare systems identify practical solutions. It shows that the problem is not just individual doctor choices but also cultural attitudes, system designs, and lack of clear guidance about when to stop testing and treating.
This is a narrative review, meaning researchers examined existing evidence rather than conducting a new experiment. While reviews don’t provide the strongest evidence type, this one synthesizes information from multiple sources and real-world programs. The authors examined international initiatives with proven track records, which strengthens the practical value of their recommendations. However, readers should know this reflects expert analysis rather than new data collection.
What the Results Show
Low-value care is extremely common in endocrinology. Doctors order excessive diagnostic tests, partly because disease definitions keep changing and expanding. For example, what counted as abnormal blood sugar 20 years ago might be considered normal today, leading to more diagnoses and treatments. This creates cascading problems: one unnecessary test leads to another test, which leads to a diagnosis, which leads to treatment, which leads to more monitoring.
These unnecessary cascades harm patients in multiple ways. People experience anxiety and worry about conditions they might not actually have. They take medications with side effects they didn’t need. They spend money on healthcare that doesn’t improve their health. Healthcare systems waste resources that could help patients with real problems.
The review found that even when doctors have clear guidelines about what not to do, they often ignore them. Doctors continue ordering unnecessary tests because of habit, fear of missing something, pressure from patients, and workplace culture that rewards action over careful thinking. Changing this requires more than just publishing guidelines; it requires changing how doctors think and how healthcare systems are organized.
The review identified that uncertainty in clinical decision-making drives much unnecessary care. When doctors aren’t sure whether a patient needs treatment, they often choose to treat rather than wait and watch. This “better safe than sorry” approach seems logical but often causes more harm than good. The review also found that evolving disease definitions expand the number of people considered sick. For instance, as doctors lower the threshold for diagnosing thyroid disease or prediabetes, more people receive diagnoses and treatments, many of whom would never develop serious illness.
This review builds on growing recognition that overdiagnosis and overtreatment are major healthcare problems. Previous research in other medical fields has shown similar patterns. This review is important because it specifically focuses on endocrinology, where these problems may be especially pronounced due to the complexity of hormone testing and the expanding definitions of metabolic diseases. The review confirms that international programs like Choosing Wisely are addressing real problems, but also shows these programs have limited impact without deeper system changes.
This review examined existing research and programs rather than collecting new data, so it cannot prove cause and effect. The review focuses on endocrinology, so findings may not apply equally to other medical fields. The authors acknowledge that while they identified problems and solutions, they cannot measure exactly how much harm low-value care causes or predict how much improvement specific changes would produce. Additionally, the review relies on published research, which may not capture all low-value practices that occur in real clinical settings.
The Bottom Line
Doctors should use clear guidelines about which tests and treatments provide real benefit and which do not. Healthcare systems should support doctors in reducing unnecessary testing through training and changed incentives. Patients should ask their doctors why specific tests are ordered and whether results will change treatment decisions. These recommendations have moderate to strong support from international programs and research, though implementing them requires sustained effort.
Endocrinologists and other doctors should care because reducing low-value care improves patient outcomes and reduces costs. Patients with hormone and metabolic conditions should care because they may receive unnecessary tests and treatments. Healthcare administrators should care because low-value care wastes resources. People should be cautious about assuming all tests their doctor orders are necessary; asking questions is appropriate and helpful.
Changes in clinical practice happen slowly. Individual doctors may start reducing unnecessary testing within months of learning about the evidence. Healthcare systems may take 1 to 3 years to implement new policies. Widespread cultural change in medicine typically takes 5 to 10 years. Patients may notice benefits immediately if they avoid unnecessary tests, but system-wide improvements take longer.
Frequently Asked Questions
Why do endocrinologists order so many tests?
Endocrinologists order excessive tests due to unclear disease definitions, habit, fear of missing diagnoses, and workplace culture favoring action. Changing disease thresholds means more people qualify for testing and treatment, even when they may never develop serious illness.
Does getting more tests and treatment always mean better health outcomes?
No. Research shows unnecessary tests and treatments often harm patients through anxiety, medication side effects, and wasted healthcare resources without improving actual health. Excessive testing can trigger cascades of unnecessary follow-up care.
What can patients do to avoid unnecessary endocrine tests?
Ask your doctor why each test is recommended and whether results will change your treatment plan. Request to skip tests if you and your doctor agree they won’t affect your care. Asking questions helps ensure your care focuses on what truly helps your health.
Are international programs like Choosing Wisely working to reduce unnecessary care?
Yes, programs like Choosing Wisely publish evidence-based recommendations about tests and treatments to avoid. However, their impact is limited because doctors continue old habits and healthcare systems don’t always support change. Deeper system transformation is needed.
How long does it take for doctors to stop ordering unnecessary tests?
Individual doctors may change within months of learning evidence, but healthcare systems typically need 1 to 3 years to implement new policies. Widespread cultural change in medicine takes 5 to 10 years because it requires changing attitudes about testing and treatment.
Want to Apply This Research?
- Track which endocrine tests you receive each visit, the results, and whether they changed your treatment. Note which tests your doctor recommended but you declined. Over time, this reveals patterns about which tests actually affect your care decisions.
- Before your endocrinology appointment, write down three questions: What tests are you recommending and why? Will the results change my treatment? What happens if we skip this test? Bringing these questions helps you and your doctor discuss whether each test is truly necessary.
- After each visit, rate whether you felt the appointment addressed your main health concerns. Track whether recommended tests led to treatment changes. Over time, this helps you identify whether your care focuses on tests or on actual health improvements. Share this feedback with your doctor to guide future decisions.
This review examines healthcare system practices and does not provide medical advice for individual patients. Do not stop or change any endocrine treatment without consulting your doctor. The findings apply to general patterns in endocrinology practice and may not reflect your specific situation. Always discuss the necessity and risks of recommended tests and treatments with your healthcare provider before making decisions about your care.
This research translation is published by Gram Research, the science division of Gram, an AI-powered nutrition tracking app.